PTH too low

Are you on dialysis? your PTH is actually in the normal range for a non-dialysis patient. If you are on already, are you being treated with IV or oral vitamin D? the typical range for someone on dialysis is 150 at the bottom end, and meds can be adjusted. Managing the "bone labs" (Calcium, Phosphorus and PTH) is a balancing act when the kidneys don't work well b/c they play a big role in keeping these bones in the "goal" ranges.

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Comment

Some 9 months pre-dialysis, whilst in Stage V ESRD my PTH rocketed up to 180. My nephrologist prescribed Calcitriol, which is an activated form of Vitamin D. In the span of a few months my PTH dropped back into the normal range for a non-dialysis patient - 70. I continued the daily dose of Calcitriol until I began HHD training and with it dialysis some 6 months later, when base line labs revealed that my PTH had dropped to somewhere in the 20's. I was instructed to stop taking the Calcitriol immediately. Since that time, I have not been able to get my PTH up to the level that is considered normal for a dialysis patient. My nephrologist and dietician tell me that this is a good problem to have. I am typically running PTH's between 40 and 90 and there is no treatment that has been suggested for low PTH.

I have PKD, still have residual kidney function and continue to produce plenty of urine. One theory for this, my limited need for Epogen to maintain Hemoglobin levels, and well balanced nutritional values that have eliminated the need for phosphorus binders is that HHD is preserving and/or enabling residual kidney function. Prior to starting dialysis, I was highly anemic (9.0 Hemoglobin), my phosphorus and potassium levels were intermittently in the red, my PTH had to be controlled with Calcitriol, I was taking three blood pressure meds (now two and 1/3 the dose on one med) and of course my creatinine, BUN and GFR were well into the Stage V range. On dialysis these values are more associated with those in Stage IV, or where I was in 2010 and some 2 years before beginning dialysis.

Comment

I am currently on dialysis and my PTH was in the normal ranges (above 100 but below 200) for several and suddenly last month dropped drastically to 40. No one at dialysis mentioned it to me but my concern is that it dropped so dramatically and since my Phosphorus is a bit too high (6.9) and I have an awful time keeping it lower. I can't afford the Renvela they want me to take but take 4 Tums with meals. Since the PTH helps regulate the Phosphorus could that be the reason for the lack of control on it? How can I get my PTH back up? I currently take oral Vitamin D supplements (15,000 units per week after dialysis on dialysis days)

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My husband has the opposite problem his PTH is too high. Before he started dialysis it was under control with zemplar. After starting dialysis it has been going up, it is up to 315. I was told to stop zemplar when he started dialysis. I asked the doctor if I could give him zemplar and he said they would give it during diaysis. So far I haven't seen it go down. I am concerned. Any feed back would be appreciated.

Comment

I wouldn't worry with a PTH of 300 as they tell me that 600 is okay for a dialysis patient. Mine is about 800 at the moment and went almost to 2000 last year. If I get back down to to the 600 range, I'm sure they'll call it fine. I don't get binders so sometimes I just self treat with tums as I get tired of hearing that my phosphorus is high, as though I cheated on my diet or something. I stay on the diet to the extreme but with no binders the phosphorus does go up on its own.

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